Phosphate-Buffered RMGIC Liner Under Pediatric Class II Composites: Clinical Sensitivity & Inflammatory Biomarkers

Abstract

Background: Post-operative sensitivity after pediatric Class II composites is frequent and relates to polymerization stress and transient inflammation. A phosphate-buffered resin-modified glass ionomer (RMGIC) liner may stabilize pH, limit inflammation, and improve comfort.

Objective: To compare a phosphate-buffered RMGIC liner with a conventional RMGIC liner under Class II composites in primary molars.

Methods: Randomized, controlled clinical study of fifty children, each contributing one tooth per group (buffered vs conventional). Standardized isolation, preparation, selective-etch bonding, and incremental composite placement were used. Outcomes: pain by 0–10 Numeric Rating Scale (NRS) and Wong–Baker FACES at 1 and 4 weeks; electric pulp testing (EPT) at baseline and 4 weeks; gingival crevicular fluid interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and prostaglandin E₂ (PGE₂) at baseline, 1 and 4 weeks; 1-week chewing function; 48-hour analgesic use; and 3-month marginal staining. Per table footnotes, between-group comparisons used independent samples t-tests for continuous outcomes and chi-square tests for proportions/categories.

Results: Baseline demographics were comparable. NRS pain favored buffering at 1 week (1.83±1.33 vs 3.78±1.80; p<0.001) and 4 weeks (0.69±0.71 vs 1.93±1.03; p<0.001); Wong–Baker differences were nonsignificant. EPT thresholds were higher with buffering at 4 weeks (32.60±5.43 vs 27.58±4.54; p=0.001). IL-6 was lower with buffering at 1 week (8.58±3.42 vs 12.00±4.76; p=0.005) and 4 weeks (6.78±2.29 vs 10.21±5.21; p=0.004); TNF-α was lower at 4 weeks (8.13±3.28 vs 14.48±5.40; p<0.001). PGE₂ differences were nonsignificant. Chewing function was better at 1 week (7.68±2.06 vs 11.80±3.98; p<0.001). Fewer children required analgesics within 48 hours (20% vs 40%; p=0.039) and fewer doses were taken (0.27±0.56 vs 0.96±1.08; p=0.006). At 3 months, marginal staining distributions were similar (p=0.538).

Conclusions: Compared with a conventional RMGIC, the phosphate-buffered RMGIC liner reduced early pain, attenuated inflammatory biomarkers, improved pulpal sensibility, and enhanced short-term function without compromising restoration integrity. These child-centered benefits support biologically informed liner selection and justify longer follow-up to confirm clinical long-term durability and survival.

Keywords:

Phosphate-buffered RMGIC, Pediatric dentistry, Class II composite, Post-operative sensitivity, Electric pulp testing, Inflammatory biomarkers, Primary molars, Bioactive liner

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